Affordable Healthcare
 
What is ObamaCare?
 
The official name for ObamaCare is the Patient Protection and Affordable Care Act, (PPACA), ir Affordable Care Act (ACA) for short. 
 
The ACA was signed into las to reform the health care industry by President Barack obama on March 23, 2010 and upheld by the Supreme Court on June 28, 2012. 
 
The goal of the ACA was to give more Americans access to affordable, quality health insurance and to reduce the growth in US health care spending. 
 
The ACA was to expand the affordability, quality, and availability of private and public health insurance through consumer protections, regulations, subsidies, taxes, insurance exchanges, and other reforms. 
 

The Good News About Obamacare:

Before Obamacare, healthcare premiums were too expensive for many families to afford. And even if you could afford it, insurance companies would deny coverage to anyone who had a preexisting medical condition, making it near impossible to get coverage if you weren't 100% healthy. Obamacare, officially known as the "Affordable Care Act," changed all of that. Now, by law, healthcare has become much more affordable and universally available. You don't need a high income or perfect health to get insured.

The Bad News About Obamacare:

Obamacare can be very confusing - the law is over 1,000 pages long!

People have been overloaded with information, some of which has been inaccurate. Some government websites have also been limited in terms of ease of use and health options offered. All this has made it difficult for people to know their options, shop around, and enroll in the plan that is truly the best fit for their income and coverage needs.

Open enrollment for 2017 health plans ended January 31st, 2017. Private Individual and family health insurance options outside of the annual open enrollment period include: Special Enrollment, Short Term Health Insurance, Medicaid, and CHIP.
 
ObamaCare’s 2018 Open Enrollment period will start November 1, 2017 and end December 15, 2017. Don’t forget to get covered at HealthCare.Gov so you can take advantage of cost assistance options! Those with lower-incomes and children should note that Medicaid and CHIP enrollment is offered 365 days a year. 
 

ObamaCare’s Key Benefits, Rights, and Protections

Below is a quick rundown of the most important benefits, rights, and protections in the Affordable Care Act. Decide for yourself what you think about the new health care law, based on the facts and not the talking points.

ObamaCare offers a number of new benefits, rights, and protections:

By the end of 2014, about 6.5 million people enrolled in a health plan on ObamaCare’s Health Insurance Marketplace HealthCare.Gov. This included 4.5 million renewals and auto-renewals in addition to the 2 million new enrollments.
 
By the end of open enrollment 2015, an estimated 11.7 million people were enrolled in state and federal marketplaces. 10.8 million more were covered through Medicaid and CHIP and 5.7 million young people were able to stay on their parents’ plan. Many more were covered through employers who expanded coverage under the ACA and on private plans outside of the marketplace. 
  • In 2016: 7 out of 10 returning Marketplace customers could get a plan for less than $75 a month, and 8 in 10 could get one for $100 or less.
Over 15 Million More Americans Have Health Insurance Due to The Affordable Care Act 
 
ObamaCare 
The percentage of US population in each category of the image above is from the Kaiser Family Foundation compilation of data for 2011. It is based on analysis by the Kaiser Commission on Medicaid and the Uninsured and the Urban Institute of the US Census Bureau’s Annual Social and Economic Supplement to the Current Population Survey (CPS ASEC). The CPS supplement is the primary source of annual health insurance coverage information in the United States.
 

TrumpCare vs. ObamaCare

What is Different About the American Health Care Act (TrumpCare) and the Affordable Care Act (ObamaCare)?

An Introduction to ObamaCare and TrumpCare

The American Health Care Act (AHCA), sometimes called TrumpCare or RyanCare (it is based on Ryan’s “the Better Way” plan), is a proposed replacement for ObamaCare AKA the Affordable Care Act (ACA).

After one failed attempt to pass the plan, House Republicans passed the latest version of their repeal and replace bill (with some additional Amendments) 217-to-213 on Thursday May 4th, 2017.

The bill will now go to the Senate for review and another vote.

Although we don’t know if the plan will pass the Senate, or what other changes might be made, we explain everything we know so far below, including how TrumpCare is different than ObamaCare.

We’ll update this page as we know more.

IMPORTANT: It is vital to note that this plan hasn’t passed the Senate and is subject to changes. Also this is a budget reconciliation bill and is unofficially phase 1 of 3 phases. That means items Trump promised on his website that aren’t related to the budget like selling across state lines, transparency reform, and litigation reform aren’t in it. Thus, one should keep in mind that although it doesn’t undo many key ACA provisions, and although it doesn’t do everything Trump promised, it doesn’t mean Republicans don’t have those agenda items in mind for phase 2 and 3. With that said, phase 1 (the TrumpCare below) focuses on budget items (so there are certain cuts and certain provisions that wouldn’t make sense in this bill). If you want to know everything planned, consider checking out our original review of Ryan’s “Better Way” plan.

TrumpCare Vs. ObamaCare: A Summary of What is Different Between ObamaCare and TrumpCare

The American Health Care Act (AHCA) keeps a lot of the Affordable Care Act (ACA) in place, but it changes a lot too.

Keeping in mind that the bill is still being debated and everything below is subject to change, the basics of what TrumpCare does can be summarized by saying TrumpCare (the American Health Care Act):

  • Repeals the mandates for both individuals to pay a fee for not having coverage and for large employers to insure their employees. Technically, it repeals the fees for the individual and employer mandates, not the mandates themselves.
  • Freezes Medicaid funding to states beginning in 2018 or 2020; exact dates are being discussed.
  • Eliminates most of ObamaCare’s taxes on those with higher incomes, employers, and industry.
  • Replaces tax credits and out-of-pocket assistance based on income with tax credits based on age although some income-based assistance, like Medicaid, remains.
  • Allows for essential health benefits to be excluded on a state-level (see the MacArthur Amendment).

NOTE: One thing to note early on here is that this plan cuts small business tax credits and cuts assistance for seniors who are not on Medicare. Neither of these is in-line with past rhetoric from Trump or the GOP.

TIP: Selling across state lines, litigation reform, transparency, and so much else is not included in this bill. It may be included in future bills, but it is not here. Sometimes the term “TrumpCare” is used to describe the overarching strategy of Republicans or all Trump’s campaign promises. Learn more about TrumpCare as a broad term, for this page we’ll focus on what is on the table and what passes (updating this all as time rolls along).

The Cost of TrumpCare According to the CBO, The Uninsured Rate Under TrumpCare, and the Controversial Planks of TrumpCare

TrumpCare also does some very controversial things in its current iteration, some of which go against Trump’s campaign promises of “more coverage” and “not letting them die on the streets” (as that quote was referring to Medicaid and certainly tens of millions are going to lose access to Medicaid).

For example, it defunds Planned Parenthood, takes away demand from healthcare providers (by creating tens of millions of uninsured), it takes away funding states could have used for state-based healthcare solutions, and takes large amounts of cost assistance away from Seniors who haven’t reached Medicare age.

However, on the plus side, it leaves some very important provisions of the ACA in place (as we’ll note below) and fixes a few things like the fee associated with the mandate and cost assistance for those between 400% – 600% of the poverty level.

The plan has a price tag that comes in under the ACA according to the Congressional Budget Office, saving $337 billion over the decade. However, it does this by leaving 52 million without coverage by 2026 (it increases the uninsured by 24 million by 2026 for a total of 52 million). The plan shifts much of the savings to tax breaks for the wealthy and notably, could have saved substantially more money if its only ends were economics.

We will discuss pros and cons, but these are the basics.

TrumpCare Vs. ObamaCare: The Major Provisions TrumpCare Changes

To illustrate what else TrumpCare does and doesn’t keep we have used a list of the key basic provisions of the Affordable Care Act and then have crossed out what TrumpCare changes (see the original list for the ACA here):

TIP: It is important to note that the current bill is designed to address budget items only, and some of the following are not budget-related. Some of these provisions could still be repealed down the road in planned Second and Third repeal phases.

ObamaCare’s benefits, rights, and protections include:

UPDATE ON ESSENTIAL HEALTH BENEFITS: After discussions between Republicans it looks like Essential Health Benefits will be subject to state-based waivers (along with a few other things). This means they can be cut on a state level. This could mean cheaper plans for some (as insurers would be able to offer fewer benefits), but could also mean that people won’t know what they are getting when they buy coverage. They could end up, for example, picking a cheap plan and then realizing it doesn’t cover any of the services they need.

UPDATE ON MEDICAID AND OTHER CHANGES: Changes were made to the bill as the Tuesday Group, Freedom Caucus, Trump, and Ryan’s conservatives cut deals. Under the changes Medicaid can have work requirements, the Essential Health Benefits may be removed, states will be able to offer more help to seniors (not at ACA levels, but still worth noting), and a few other subtle things will change. Learn more about the policy changes and the new CBO scoring (only slight changes were made), but they do matter.

ON DEFUNDING MEDICAID: Federal funding for Medicaid continues for states that expanded coverage under the Affordable Care Act through 2019 (or 2017 depending on the final bill; this is subject to change). However, starting January 1, 2020, federal funding to those states will continue but be frozen based on how many were covered by the end of 2019 (or 2017). Then, beginning in 2020, Medicaid funding to states will be a fixed amount based on the total number of Medicaid enrollees (per capita), and not based on the actual cost of Medicaid services provided to individual recipients. This will decrease the number of people eligible for Medicaid over time, especially as the population increases over time. This means, logically, more and more of our poorest will be without healthcare options each year (or the quality or cost of coverage must go down), but it also means spending will be kept in line.

TrumpCare Also Does the Following

The following are some of the major changes made by the AHCA:

  • The Individual Mandate stays, but the fee is retroactively repealed starting December 31, 2015. That means people won’t be charged a fee for not having coverage (although there is a fee paid directly to insurers for 12 months for buying back in).
  • The Employer Mandate stays, but the fee is repealed. That means fewer full-time employees will be offered coverage as there will be no penalty for not offering coverage.
  • The mandate is “essentially” replaced by a Continuous Coverage Provision. Insurers will be required to charge 30% more on premiums for 12 months for those who have a gap in coverage of 63 days or longer.
  • Medicaid funding will be frozen by 2020 (date subject to change), and a high-risk pool of sorts will be implemented. This pool helps to offset the newly uninsured. TIP: See details. This issue is complex. Many of the uninsured come from this provision.
  • Tax credits will start being based on age rather than income starting in 2020. The new tax credits will be flat ($2,000 for individuals up to age 29 and increase in $500 increments until capping at $4,000 for individuals age 60 and older). Credits will be gradually reduced for individuals with yearly incomes exceeding $75,000 and for households that earn over $150,000.
  • Employees won’t have access to tax credits, but after 2020 the new age-based credits can be used for any individual health insurance policy regardless of where it’s purchased.
  • Metal tiers and some minimum benefit standards are removed. Thus, the line between catastrophic coverage and major medical coverage will be blurred. TIP: this could mean “junk plans” could once again be sold. It could also mean lower costs, especially after tax credits for those without high Medical costs.
  • Ratios for what seniors can be charged by insurers for premiums increase from three times what the youngest enrollees are charged to five times.
  • Planned Parenthood will be Defunded; funding would be given to Community Health Centers instead. Many of these do not yet exist and would have to be created.
  • The Medicare Part A Tax increase of 0.9% over $200,000 for an individual or $250,000 for a family would be repealed.
  • The Medicare Tax on Investment Income of 3.8% over $200,000 for an individual or $250,000 for a family would be repealed.
  • Contribution limits for Health Savings Accounts (HSAs) will be increased substantially, but one still needs a High Deductible Account and the money to fund it.
  • The Annual contribution limit to health Flexible Spending Accounts (FSAs) will be repealed. The ACA capped this limit.
  • The 40% Excise Tax “Cadillac” on high-end employer-sponsored health plans is suspended for tax years 2020 through 2024. This has already been kicked down the road by Democrats and Republicans.
  • The 10% tax on tanning beds would be repealed.
  • The $500,000 Annual Executive Compensation Limit for Health Insurance Executives will be repealed.
  • The tax on brand name drugs will be repealed.
  • The tax on health insurers will be repealed.
  • The 2.3% tax on medical device manufacturers will be repealed.

TIP: The ACA included about 20 tax provisions; the AHCA undoes most of them. The list above is not exhaustive. Learn more about the taxes in the ACA and what the AHCA gets rid of.

The Bottomline on TrumpCare

The bottom line on the ACA vs. AHCA is perhaps best expressed by the following points:

  • The American HealthCare Act gives Americans making between 400% – 600% of the poverty level, large employers, young healthy people, and industry a break in costs via tax cuts and deregulation.
  • The plan presents some real complications for the sick, poor, low-income workers, seniors, and women due to reduced assistance and the defunding of planned parenthood, higher age ratios and less assistance for non-Medicare seniors, the freezing of Medicaid Expansion, and the focus on tax breaks and HSAs over assistance.
  • Healthcare providers will lose countless patients, and this could cause a health ,care provider crisis.
  • Young people are not incentivized to get plans and this could cause a problem with insurance.
  • Employees who just got coverage and small employers will lose assistance, but large employers won’t be burdened with the complexities of choosing between health care and full-time employees.

Thus, the bottom line here is that the law reduces costs for the wealthy, healthy, and young and substantially raises costs for many in other demographics.

The middle class won’t notice much difference unless they get sick and go without coverage. Our poorest people, women, seniors, and low-wage workers will see some new hurdles.

Those with higher incomes will most certainly benefit.

FACT: Single policyholders in the non-group market stand to see premiums that are 15% to 20% higher than under current law, however as the years roll along, costs are projected to come down to prices as much as 10% than the current law. To be fair, this would be true for the ACA too. The prices were projected to spike and then to go down. That is not being acknowledged by Trump or Ryan who instead choose to use terms like “death spiral.”

Updated as of May 29, 2017